NCLEX RN Questions and Answers: 2026 June Study Guide with Practice Questions

NCLEX RN Questions and Answers: 2026 Study Guide

What You're Actually Facing on Test Day

The NCLEX RN isn't a memory test. It never was. Every question on the exam measures one thing: clinical judgment — your ability to look at a patient situation, prioritize what matters, and act correctly. That's why nursing school flashcards don't cut it alone. You need practice with real NCLEX RN practice questions that force you to think, not just recall.

This guide gives you 15 NCLEX-style questions covering the five core content areas: pharmacology, medical-surgical, OB/maternity, psychiatric nursing, and pediatrics. Each question includes the correct answer and a detailed rationale explaining the clinical reasoning — the "why" behind each choice. Study the rationale as hard as you study the answer.

The 2026 NCLEX RN uses the Next Generation NCLEX (NGN) format with a CAT (computerized adaptive testing) engine. You'll see between 85 and 150 items. The exam adapts in real time — harder questions appear when you're above the passing standard, easier ones when you're below. Your test ends when the algorithm is confident in your competency level. Knowing that, your job isn't to "pass" each question — it's to build the clinical judgment that keeps you above the cut line, consistently.

Quick heads-up: if you want NCLEX exam practice questions organized by content category or difficulty, the structured practice tests on this site let you filter by topic. But first — work through these 15 questions cold, without hints. Then read every rationale, even for the ones you got right. You'll learn something.

Pharmacology Questions — Medications, Safety, and Adverse Effects

Question 1: A nurse is caring for a patient receiving IV heparin for a pulmonary embolism. The patient reports sudden back pain and the nurse notices the urine has turned dark red. Which action should the nurse take first?

A. Slow the heparin infusion rate
B. Stop the infusion and notify the provider immediately
C. Obtain a urine culture and sensitivity
D. Reassure the patient that dark urine is expected with heparin

Answer: B — Stop the infusion and notify the provider immediately.

Dark red urine combined with sudden back pain signals retroperitoneal hemorrhage — a serious bleeding complication. Heparin must stop immediately. This is Maslow: address the physiological threat first. Slowing the drip (A) doesn't stop the bleed. Urine culture (C) treats infection, not hemorrhage. Dark urine is never expected on heparin (D) — that's a dangerous misconception.

Question 2: A patient is prescribed metformin 500 mg PO BID for type 2 diabetes. Which finding in the morning lab results should the nurse report to the provider before administering the medication?

A. Blood glucose 210 mg/dL
B. Serum creatinine 2.4 mg/dL
C. Hemoglobin A1c 8.9%
D. Sodium 138 mEq/L

Answer: B — Serum creatinine 2.4 mg/dL.

Metformin is renally cleared. Creatinine 2.4 mg/dL indicates significant kidney impairment — metformin accumulates, causing lactic acidosis. The nurse holds the dose and calls the provider. Elevated glucose (A) and A1c (C) are exactly why the patient is on metformin — not reasons to hold it. Sodium 138 (D) is within normal range.

Question 3: A nurse is preparing to administer digoxin 0.125 mg PO to a patient with heart failure. The patient's apical pulse is 54 bpm. What is the appropriate action?

A. Administer the digoxin as ordered
B. Hold the medication and recheck the pulse in 30 minutes
C. Hold the medication and notify the provider
D. Administer half the dose and document the reduced rate

Answer: C — Hold the medication and notify the provider.

The standard parameter for digoxin is hold if the apical pulse is below 60 bpm. A rate of 54 meets that threshold — hold and call. Waiting 30 minutes (B) delays necessary provider notification. Cutting the dose (D) isn't a nursing-scope decision without an order. When in doubt on cardiac meds: hold and notify.

Medical-Surgical Questions — The Core of the NCLEX

Question 4: A patient post-op day 1 after abdominal surgery reports pain rated 7/10 and has a respiratory rate of 10 breaths/min following morphine administration. Which intervention takes priority?

A. Administer the next scheduled dose of morphine as ordered
B. Instruct the patient to use incentive spirometry
C. Notify the provider and prepare to administer naloxone
D. Reposition the patient to improve comfort

Answer: C — Notify the provider and prepare to administer naloxone.

RR of 10 after opioids = respiratory depression. That's an airway emergency — ABC takes priority over pain management. Naloxone (Narcan) reverses opioid effects. More morphine (A) would worsen it. Spirometry (B) and repositioning (D) don't address the immediate respiratory threat.

Question 5: A patient with chronic kidney disease (CKD) Stage 4 has a serum potassium of 6.2 mEq/L. The nurse should anticipate which intervention first?

A. Administer sodium polystyrene sulfonate (Kayexalate)
B. Prepare for hemodialysis
C. Place the patient on continuous cardiac monitoring
D. Restrict dietary potassium

Answer: C — Continuous cardiac monitoring.

Hyperkalemia at 6.2 mEq/L risks fatal dysrhythmias. The immediate priority is monitoring for cardiac changes — tall peaked T-waves, widened QRS, or ventricular fibrillation. Kayexalate (A) works over hours. Dialysis (B) is a later intervention if medication fails. Dietary restriction (D) is a chronic management strategy. Monitor the heart first — always.

Question 6: A patient with a new colostomy is being discharged. Which statement by the patient indicates they need more teaching?

A. "I'll empty the pouch when it's one-third to one-half full."
B. "I should change the entire appliance system every 1–2 days."
C. "I'll notify my doctor if I see a prolapse or dark purple stoma."
D. "I can shower with the pouch off."

Answer: B — Changing every 1–2 days is incorrect.

The skin barrier and pouch system should last 3–7 days with proper care — not 1–2 days. Daily changes damage the peristomal skin and increase cost unnecessarily. The other statements are correct: empty at one-third to one-half full (A), report stoma changes (C), and showering without the pouch is fine (D).

Question 7: A patient with a chest tube following pneumothorax has continuous bubbling in the water-seal chamber. What should the nurse do?

A. Document this as normal chest tube functioning
B. Clamp the chest tube immediately
C. Assess for a leak in the tubing connections
D. Increase the suction pressure

Answer: C — Assess for a leak in the tubing connections.

Continuous bubbling in the water-seal chamber means there's an air leak somewhere in the system — either the patient's lung is still leaking or there's a loose connection. Intermittent bubbling is normal during expiration. Continuous bubbling is not. Clamping (B) can cause tension pneumothorax. Increasing suction (D) doesn't fix a leak. Start by checking all connections — tighten them and see if bubbling stops.

OB/Maternity Questions — Priority and Safety

Question 8: A laboring patient at 38 weeks gestation has a fetal heart rate (FHR) of 90 bpm that has persisted for 3 minutes. What is the nurse's priority action?

A. Continue monitoring and document the finding
B. Reposition the patient to the left lateral position and apply oxygen
C. Increase the IV fluid rate
D. Notify the charge nurse only

Answer: B — Reposition and apply oxygen.

Fetal bradycardia below 110 bpm for more than 2 minutes is a non-reassuring pattern — act immediately. Left lateral position relieves aortocaval compression and improves uteroplacental blood flow. Oxygen at 8–10 L/min via face mask increases fetal oxygen delivery. Then call the provider. Waiting and documenting (A) wastes critical time. Fluids (C) help with cord compression secondary to hypotension, not the first move here.

Question 9: A postpartum patient at 12 hours after vaginal delivery has a uterine fundus that is boggy, displaced to the right, and located 2 cm above the umbilicus. What should the nurse do first?

A. Massage the fundus firmly
B. Assist the patient to void
C. Administer oxytocin as ordered
D. Notify the provider of hemorrhage risk

Answer: B — Assist the patient to void.

A displaced uterus — especially displaced to the right — almost always means a full bladder. The bladder sits anterior to the uterus; when distended, it pushes the uterus up and to the side, preventing proper contraction. Empty the bladder first, reassess. If the fundus is still boggy after voiding, then massage and oxytocin. Skipping to fundal massage (A) or oxytocin (C) before checking bladder status is wrong sequence.

Psychiatric and Pediatric Questions — Don't Underestimate These

Question 10: A patient with schizophrenia tells the nurse, "The television is sending me secret messages that I'm in danger." How should the nurse respond?

A. "The television can't send personal messages — that's not possible."
B. "I understand this feels very real to you. You're safe here with us."
C. "Let's turn off the television so the messages stop."
D. "Have you taken your medication today?"

Answer: B — Acknowledge feelings without reinforcing the delusion.

Never argue with a delusion (A) — it damages trust and won't work. Turning off the TV (C) validates the delusion as real. Jumping to medication compliance (D) is dismissive. The therapeutic response acknowledges the patient's emotional experience — fear, distress — without agreeing that the TV is actually sending messages. "You're safe here" addresses the underlying need: security.

Question 11: A patient with major depressive disorder says to the nurse, "There's no point anymore. I've given away most of my things this week." What is the priority nursing intervention?

A. Encourage the patient to talk about their feelings
B. Notify the provider and document the interaction
C. Conduct a direct suicide risk assessment
D. Review the patient's medication list for antidepressants

Answer: C — Conduct a direct suicide risk assessment.

Giving away possessions is a classic warning sign for suicide planning. The priority is assessing the actual risk — ask directly: "Are you thinking about hurting yourself?" Asking directly does not plant the idea. It opens the door. Notification (B) follows assessment. Encouraging talking (A) is supportive but not the immediate priority when a behavioral red flag is present. Medication review (D) is not the first move.

Question 12: A 4-year-old child is admitted with suspected epiglottitis. Which action should the nurse avoid?

A. Preparing emergency airway equipment at the bedside
B. Keeping the child with a parent for comfort
C. Using a tongue depressor to visualize the throat
D. Monitoring oxygen saturation continuously

Answer: C — Never use a tongue depressor in suspected epiglottitis.

Stimulating the epiglottis in this condition can trigger complete airway obstruction — immediately. This is an absolute contraindication. Don't examine the throat, don't take throat cultures, don't even lay the child down if they're sitting forward (tripod position means they're maintaining their own airway). Have equipment ready (A), keep parents nearby (B), and monitor SpO2 (D) — these are all correct.

Question 13: A 2-year-old is brought to the ER with scattered bruises in various stages of healing on the back, buttocks, and thighs. The parents say the child "falls a lot." What should the nurse do first?

A. Assess the child further and document findings objectively
B. Confront the parents about the suspected abuse
C. Discharge the child with follow-up instructions
D. Ask the parents to leave the room and interview the child

Answer: A — Assess and document findings objectively.

The nurse's first responsibility is assessment and documentation — factual, nonjudgmental, anatomically specific. "Multiple bruises in various stages of healing on posterior surfaces" is what gets written down. Confronting parents (B) can increase risk to the child and isn't the nurse's role. Discharging (C) is dangerous. A 2-year-old can't reliably be interviewed alone (D). The nurse then reports suspicion to the provider and social work — mandatory reporting follows assessment.

Two More — Delegation and Infection Control

Question 14: The nurse is delegating care for four patients. Which task is appropriate to delegate to an unlicensed assistive personnel (UAP)?

A. Performing a focused respiratory assessment on a patient post-bronchoscopy
B. Assisting a stable patient with ambulation to the bathroom
C. Administering a scheduled oral medication to a patient with dysphagia
D. Teaching a diabetic patient about foot care before discharge

Answer: B — Assisting a stable patient with ambulation.

UAPs can help with ADLs for stable patients: bathing, feeding, ambulating, positioning. Assessment (A) is always a nursing function — RN only. Medication administration (C) requires nursing licensure in most states, especially with a complication like dysphagia. Patient teaching (D) is a licensed nurse responsibility. The rule: delegate tasks that don't require clinical judgment or assessment.

Question 15: A nurse is caring for a patient with active pulmonary tuberculosis (TB). Which type of transmission-based precaution applies?

A. Contact precautions only
B. Droplet precautions
C. Airborne precautions
D. Airborne plus contact precautions

Answer: C — Airborne precautions.

TB is transmitted by airborne droplet nuclei — particles smaller than 5 microns that stay suspended in air. Airborne precautions: private negative-pressure room, N95 respirator (not a surgical mask), door kept closed. Contact precautions (A) address skin/environmental transmission — wrong pathogen type. Droplet precautions (B) apply to influenza, meningitis, pertussis — particles >5 microns that fall quickly. TB needs the full airborne protocol.

These 15 questions don't cover everything — the NCLEX tests hundreds of concepts. But if you understood the clinical reasoning in each rationale, you're already thinking the way the exam rewards. The pattern is consistent: identify the immediate threat, apply the correct framework (ABCs, Maslow, therapeutic communication), act within scope, document. Practice more with NCLEX exam practice questions grouped by category, or use the full timed practice tests to build your pacing. Either way: repetition with rationale review is the method. There are no shortcuts — but there is a system.